Mazzotta Cosimo, Balamoun Ashraf Armia, Chabib Ayoub, Rechichi Miguel, D'Oria Francesco, Hafezi Farhad, Bagaglia Simone Alex, Ferrise Marco
Departmental Ophthalmology Unit, Alta Val d' Elsa Hospital, USL Toscana Sudest, Post Graduate Ophthalmology School, University of Siena, Siena Crosslinking Center Siena Italy, 53100 Siena, Italy.
Watany Research and Development Center, Ashraf Armia Eye Clinic and Al Watany Eye Hospital, Cairo 11511, Egypt.
J Clin Med. 2022 Aug 27;11(17):5039. doi: 10.3390/jcm11175039.
To assess the 3-year clinical results of the 18 mW 7 J/cm transepithelial enhanced fluence pulsed light M accelerated crosslinking in the treatment of progressive keratoconus (KC) with chemically enhanced hyper-concentrated riboflavin solutions without iontophoresis and with air-room oxygenation.
Siena Crosslinking Center, Siena, Italy.
Prospective pilot, open non-randomized interventional study including 40 eyes of 30 young adult patients over 21 years old (10 simultaneous bilateral) with early (Stage I and II) progressive KC undergoing TE-EFPL 18 mW/7 J/cm ACXL (EFPL M TECXL). The 12 min and 58 s pulsed light (1 s on/1 s off) UV-A exposure treatments were performed with a biphasic corneal soaking using Paracel I 0.25% for 4 min and Paracel II 0.22% for 6 min riboflavin solutions and New KXL I UV-A emitter (Glaukos-Avedro, Waltham, USA) at an air room of 21% oxygenation. All patients completed the 3-year follow-up.
CDVA showed a statistically significant improvement in the third postoperative month (Δ + 0.17 d. e.) with a final gain of +0.22 d. eq. AK showed a statistically significant decrease in the sixth postoperative month (Δ - 1.15 diopters). K itmax showed a statistically significant decrease at 1-year follow-up (Δ - 1.3 diopters). The coma value improved significantly by the sixth month (Δ - 0.54 µm). MCT remained stable during the entire follow-up. No adverse events were recorded. Corneal OCT revealed a mean demarcation line depth at 282.6 ± 23.6 μm.
Transepithelial enhanced fluence pulsed light M accelerated crosslinking with chemically enhanced riboflavin solution halted KC progression in young adult patients without iontophoresis and no intraoperative oxygen supplementation addressing the importance of increased fluence.
评估采用18毫瓦、7焦/平方厘米经上皮增强能量密度的脉冲光M加速交联，联合化学增强的高浓度核黄素溶液且不进行离子导入、采用空气室氧合的方法，治疗进展期圆锥角膜（KC）的3年临床效果。
意大利锡耶纳交联中心。
前瞻性试点、开放非随机干预性研究，纳入30例21岁以上年轻成年患者的40只眼（10例为同时双侧），这些患者患有早期（I期和II期）进展期KC，接受经上皮增强能量密度脉冲光18毫瓦/7焦/平方厘米加速交联（EFPL M TECXL）。使用Paracel I 0.25%溶液浸泡角膜4分钟，然后用Paracel II 0.22%溶液浸泡6分钟，通过双相角膜浸泡法进行12分58秒的脉冲光（1秒开/1秒关）紫外线A照射治疗，使用New KXL I紫外线A发射器（美国沃尔瑟姆的Glaukos-Avedro公司），在氧气含量为21%的空气室中进行。所有患者均完成了3年随访。
术后第三个月，矫正远视力（CDVA）有统计学意义的改善（Δ +0.17对数视力单位），最终提高了+0.22对数视力单位。术后第六个月，角膜散光（AK）有统计学意义的降低（Δ -1.15屈光度）。随访1年时，最大角膜曲率（K itmax）有统计学意义的降低（Δ -1.3屈光度）。术后第六个月，彗差值显著改善（Δ -0.54微米）。在整个随访期间，角膜地形图（MCT）保持稳定。未记录到不良事件。角膜光学相干断层扫描（OCT）显示平均分界线深度为282.6±23.6微米。
采用经上皮增强能量密度的脉冲光M加速交联联合化学增强的核黄素溶液，在不进行离子导入且术中不补充氧气的情况下，可使年轻成年患者的KC进展停止，凸显了增加能量密度的重要性。
